Intra Cytoplasmic Sperm Injection (ICSI)

During Intra Cytoplasmic Sperm Injection method (ICSI), a single sperm is injected directly into the cytoplasm of the egg by an embryologist, having selected the sperm that are most active and healthy. It is indicated when sperm is either of low quality or quantity, when the sperms are surgically retrieved, when there has been previous failed or low fertilization with IVF (In Vitro Fertilization).Hence,  ICSI allows the use of sperm that may not otherwise have been able to fertilize an egg.  

The egg is examined for signs of fertilization as soon as 17–20 hours after ICSI. Over time, it has been found that around 80% of the eggs will be fertilized, except for couples that have severe infertility factors. 2% of all the “normal” looking sperm and eggs do not get fertilized even when the ICSI method is used. 

 Embryos are usually found in different stages and grades after being fertilized. The quality of the embryo is assessed by an embryologist, who will then provide you with the necessary information. The embryos thus formed, are transferred back to the uterus either after 2, 3 or 5 days or frozen for future use.

It is important to note that every couple is different. So it is important that proper tests are taken and that their medical history is discussed with a specialist before choosing to go for a particular method. 

HealthPlus is fully committed to ensuring that every patient’s dream of becoming a parent is achieved.

Dr. Ripal Madnani

Dr. Madnani has more than 15 years of medical experience in Obstetrics and Gynecology with 12 years of specialist experience in Reproductive Medicine and Infertility. Prior to joining, she worked at First IVF and Day Surgery Centre FZ-LLC, Dubai as a Specialist Reproductive Medicine and Infertility. She also gained experience in Bahrain and India, where she worked as an Obstetrician, Gynecologist and IVF Specialist between 2013 and 2022, treating several couples with fertility related issues.

In her new role at HealthPlus Fertility Center Abu Dhabi, Dr Madnani will be working as a Specialist in Reproductive Medicine and Infertility.

Dr. Madnani graduated and obtained her MBBS degree in 2008 from Maharaja Sayajirao University of Baroda, India. She had her residency training in Obstetrics & Gynecology at Medical College Baroda, India from 2008 till 2011 and was then awarded the Doctor of Medicine (Obstetrics and Gynaecology) degree. Subsequently, she completed 2 years of clinical fellowship in Reproductive Medicine and Infertility at the Institute of Kidney Diseases & Research Centre, India from 2011 till 2013.

Dr. Madnani was certified Diplomate of National Board in Obstetrics and Gynaecology in 2019, admitted as European Fellow of Obstetrics and Gynaecology of EBCOG in 2021, and is a Member of the Royal College of Obstetricians and Gynaecologists since 2022.

Dr. Madnani’s scope of practice includes but not limited to Recurrent Implantation (IVF) failure, complicated IVF cases, poor ovarian reserve, endometriosis related infertility, PCOS and infertility, fertility preservation for singles and married couples, immune factors related infertility, and fertility enhancing laparoscopic surgeries.

Assisted Reproduction

Assisted reproduction involves a set of processes by which eggs, sperm, or both are handled outside the body. There are several assisted reproduction methods that are now commonly used. They include in vitro fertilization (IVF), intrauterine insemination (IUI).

Intrauterine Insemination

During an intrauterine insemination (IUI) procedure, a small catheter is used to insert sperm into the uterus. This helps to increase the number of healthy sperm that reaches the woman’s fallopian tube when she is fertile, thereby increasing the chances of fertilization. IUI has become popular because it is cheaper than in vitro fertilization and is not as invasive.

In Vitro Fertilization

The most common form of assisted reproduction treatment is in vitro fertilization (IVF). Vast majority of IVF cycles are performed with some type of ovarian stimulation. Ovarian stimulation is usually started on the second or third day of your menstrual cycle. Ovarian stimulation involves using fertility medications to cause multiple eggs to grow and at the same time prevent premature ovulation. Once the eggs (follicles) are ready for egg retrieval, you will be administered an injection to trigger ovulation. Following the final trigger, egg retrieval is performed under anesthesia. Egg retrieval is known by several names, including ovum pick up, egg pick up and egg collection. During this procedure, the physician inserts an ultrasound probe into the vagina and then uses a needle to withdraw the egg from each follicle (takes approximately 15-30 minutes) depending upon how many follicles are present. After the retrieval procedure, the eggs are combined with sperm in a laboratory dish so they will fertilize. This produces an embryo. The embryo that is produced is then placed back into her uterus on the 2nd, 3rd or the 5th day, where it implants and begins to grow. When more than one embryo is transferred, there is a possibility of having multiple births, such as twins or even more.

Many people view in vitro fertilization as the last resort for all infertility problems. But of all the assisted reproduction techniques, it has a high success rate. 

Since the introduction of assisted reproduction, it has become more likely for all couples to have a healthy pregnancy. There are methods that would suit anyone as long as their medical history is analyzed properly by their specialists. These methods also ensure that you have control over your body concerning when you want to become pregnant and the kind of spacing you want between children.

Contact HealthPlus today to make an appointment with a specialist who will attend to you and to whom you can ask all the questions that you may have.

Pre-implantation Genetic Testing (PGT)

At HealthPus, there is an ultramodern genetics laboratory that is fully equipped to perform genetic testing on the embryos that are created using in vitro fertilization (IVF). 

Through genetic testing, a large amount of information can be acquired about an embryo before it is transferred to the uterus. After the formation of an embryo via an IVF cycle that occurs following the egg collection and ICSI, the embryo is tested by taking a few cells from it. The embryo is not transferred to the uterus until the results are released.

  1. Comprehensive Chromosomal Screening (CCS): Here, all the 24 chromosomes are screened to determine the gender as well as to find out if there are any missing or additional chromosomes. Abnormalities in chromosomes are one of the major causes of miscarriage.
  2. Gender Selection: This is the screening of the embryos so that the gender can be determined as well as for chromosomal abnormalities.
  3. Pre-implantation Genetic Testing: The embryos can be tested for all the 24 chromosomes before they are transferred into the uterus. This is called pre-implantation genetic testing.
    • PGS (screening) – involves testing of embryos for chromosomal abnormalities.
    • PGD (diagnosis) – involves testing the embryos for a specific known genetic or hereditary disease to ensure that the child does not have it as well.
  4. HLA matching: An HLA (HumanLeukocyte Antigens) matching is used to identify embryos that are HLA compatible with a child who needs bone marrow or cord blood transplant. The child (or the future sibling) of such tissue is often called  a Savior sibling. 

There are three different methods that can be used to identify hereditary diseases in an embryo. After tests and counselling, a method of testing will be settled on. Pre-implantation Genetic Diagnosis (PGD) is usually recommended during the IVF cycle if a genetic mutation is found so that the disease is not transferred.

  • Mutation screening is used to detect mutations present in small genes or genetic diseases that can only be caused by a small number of mutations.
  • Exome Screening is used to check for hereditary diseases that have yet to be identified or for diseases that involve the interaction of two or more genes. Exome Screening has the capacity to analyze tens of thousands of genes at a time.

Blood tests can also be carried out to ensure that there is very little chances of children having the same hereditary diseases as the parents. A common example is the Premarital or Preconception Screening that is done for couples that have a known hereditary disease in their family history and want to be sure that there is no possibility of their children inheriting such a disease.

Dr. Walid Sayed

Dr. Walid Sayed started his career in the fertility field in Germany from 1995 until 2006. He worked as a Specialist in Gynecological Endocrinology and Reproductive Medicine in three IVF centers in Germany.

In 2006, he moved to UAE and hold a Consultant position in the Gynecological Endocrinology and Reproductive Medicine in Tawam Hospital, Al Ain.

In 2009, he moved to Abu Dhabi and founded HealthPlus Women’s Center and in 2011 he launched the HealthPlus Fertility Center. Since then he hold the position of Group Medical Director of HealthPlus Abu Dhabi and Dubai. During his journey, he held multiple presentations and attended multiple conferences all over the world.

Surgical Sperm Retrieval

Surgical Sperm Retrieval is a method by which sperm is collected directly from the testis or epididymis of a man. The procedure is usually planned ahead and is done while the patient is under a general or local anesthesia, but it can also be done immediately, if necessary, in the case of an emergency. This is usually in a situation where the man is not able to produce semen on the day his partner’s egg is to be collected.

Techniques of Surgical Sperm Retrieval

There are different techniques by which sperm can be retrieved surgically. The technique used depends on whether the testicles do not produce enough sperm during normal ejaculation or the sperm are not able to reach the seminal fluid because of a blockage in the tube that carries the sperm from the testis.

 1. Percutaneous Epididymal Sperm Aspiration (PESA)

PESA is a very quick SSR procedure and relatively painless. It is the least invasive technique and does not require surgical incision. The process is carried out by inserting a needle into the epididymis from which fluid is removed. The fluid removed is examined by embryologists for sperm content and motility. If no viable sperm is found, then another method will be used.

2. Testicular Sperm Aspiration (TESA)

In TESA, a fine needle together with a biopsy gun is used to remove small lengths of the seminiferous tubule that produce sperm. These tubules are then dissected carefully and examined under a microscope to detect sperm which can be used for ICSI or frozen for later use.

3. Micro-epididymal Sperm Aspiration (MESA) 

A small cut is made which passes through the scrotum and into the epididymis instead of using a needle as in PESA. The fluid removed is then examined under the microscope for viable sperm following the same technique.

4. Testicular Sperm Extraction (TESE) / Micro TESE

This method is used only if no sperm is found when the others are used. In TESE, the tissue is gotten after an incision has been made to open the scrotum. The tissue is cut and taken to the IVF lab where it would be prepared.

Micro TESE, is performed under general anesthesia by a surgeon (usually a urologist) using an operating microscope. A scientist takes samples and seeks live sperm in the samples removed from the testis. This is highly skilled work.

Dr. Wael Ismail Madkour

Consultant, Reproductive Endocrinology & Infertility (IVF)

Dr. Wael Ismail Madkour is an Obstetrics & Gynecology, Fertility & Reproductive Endocrinology (IVF) Consultant at HealthPlus Fertility Center. Dr. Wael has more than 28 years of experience in many leading healthcare organizations in Egypt, UK and UAE. Before joining HealthPlus Fertility Center, Dr. Wael was the Assistant Director for Medical Affairs and Obstetrics & Gynecology and Reproductive Medicine Consultant in one of the leading fertility centers in UAE, part of Dubai health Authority in Dubai.

Dr. Wael specializes in Assisted Reproductive Techniques and is interested in the sub-specialty of Gynecological Endoscopy. He is also a Professor in Obstetrics & Gynecology at Ain Shams University, Egypt. He earned his post graduate training in Egypt where he obtained his MD degree & then moved to the UK to continue his post graduate training in the General field of Obstetrics & Gynecology where he worked for many leading teaching hospitals in the NHS Trusts. After obtaining his Royal college membership in 2000, he got a fellowship training in ART/ IVF in the Assisted conception unit – Royal infirmary of Edinburgh- UK. While working for Dubai Health Authority, besides his clinical duties, he was part of the regulatory authority, as he led the team responsible for licensing in IVF through DHA as well as HAAD & MOH. Also this team was responsible for licensing & inspecting IVF units in Dubai and other Northern Emirates.

Dr. Wael earned his MBBCh with honors from Ain Shams University, Egypt, 1990. He is a Fellow of the Royal College of Obstetricians & Gynecologists, UK. Dr. Wael is a member in the British Fertility Society, European Society for Human Reproduction & Embryology, Edinburgh Obstetric Society, Emirates Obstetrics & Gynecology Society. Lately, he obtained his Professorship degree in Obstetrics & Gynecology from the board of the Higher Council of Egyptian Universities, Egypt, 2016.

Laparoscopic Ovum Pick-up Technique

Laparoscopic Ovum Pickup technique is a method by which an egg is collected for use in IVF. 

This method involves using a fibre-optic nerve to which a small camera is attached and being inserted into the abdomen via a small cleft under the belly button. The abdominal cavity is then filled with carbon dioxide to produce working space. After the eggs have been collected, the clefts are then stitched closed using absorbable stitches.

Three instruments are inserted into the abdomen during a laparoscopy procedure for ovum pick up. As a result, three small incisions are made, of which one or two will need to be stitched.

The laparoscope is placed through a small incision made at the lower edge of the belly button. This allows the doctor to see the ovaries and follicles holding the eggs. The second incision is made on one side of the abdomen, and an instrument used to hold the ovaries in place is inserted through it. In the third incision, the needle that will be used to remove the eggs is inserted.

Vaginal Ultrasound Collection

In this procedure, the eggs to be used are collected using the vaginal ultrasound egg collection method. During this procedure, the physician inserts an ultrasound probe into the vagina and then uses a needle to withdraw the egg from each follicle (takes approximately 15-30 minutes) depending upon how many follicles are present. Using the ultrasound as a guide, it is a lot easier to insert the needle and then extract fluid from every follicle because the image of what has been done is shown on the ultrasound screen.

As with every procedure, there are certain risks associated with it, and there is no certainty concerning the result. But at HealthPlus, you can be sure that you will be attended to by the best specialists around. Contact us to book an appointment or ask any questions that you might have in mind.

Dr. Ahmed Elbohoty

Professor Ahmed Elbohoty is our Fertility & Reproductive Medicine (IVF) and Gynaecology Consultant at HealthPlus Fertility Center in Dubai. He has more than 20 years of experience where he worked in the leading fertility centers in Egypt and UAE. He is a professor in the faculty of medicine with a special interest in infertility management, preimplantation genetic testing, PCOs, recurrent implantation failure, poor responders and minimal invasive endoscopic surgeries including advanced hysteroscopic and laparoscopic surgeries. Prof. Elbohoty graduated from Ain Shams University- Egypt (MBBCh) with Honours in 2001, where he then obtained MSc & MD in Reproductive Medicine in 2006 and 2009 respectively, and he is a Gynaecology professor in the same university. He was admitted as a member of the Royal College of Obstetricians & Gynaecologists in London in 2013. He obtained the Minimal Invasive Gynaecological Surgeon Certificate from European Gynaecologic Academy of Endoscopic Surgery in 2016 in Belgium. He was certified as a European Fellow of reproductive medicine since 2022. He was also certified by ESHRE as an endoscopic reproductive surgeon. Dr. Elbohoty is the author of more than 20 peer-reviewed papers published in international medical journals in the field of Reproductive Medicine.